Musculoskeletal Injuries

Question 1

Quais são os sinais e sintomas de uma lesão musculoesquelética significativa?

Answer 1

Pain and point tenderness; swelling or effusion; deformity or angulation; discoloration of the skin; exposed bone ends or visible bone fragments; inability to use/move the afected body part; joint locked into position; bones granting or a snap/pop heard by the athlete; DOTS (deformity, over wounds, tenderness, swelling).

Question 2

Quando chamar a serviço de emergência?

Answer 2

Sangramento severo; a lesão limita a habilidade para respirar ou deabular; qualquer envolvimento de cabeça, pescoço ou coluna; áreas múltiplas de lesão; choque. Utilizar RICE (rest, ice, compression, elevation) e/ou imobilização.

Question 3

Qual o objetivo da imobilização?

Answer 3

Diminuir a dor; prevenir danos adicionais nos tecidos; reduzir o risco de sangramento sério; reduzir a possibilidade de perda de circulação sanguínea na àrea; prevenir que lesões fechadas se tornem abertas.

Question 4

Quais são os princípios de aplicação de talas (splint)?

Answer 4

Colocar tala apenas se for possível não causar dor ou desconforto à vitima; fazer tala na posição em que foi encontrada (manter a posição); a tala deve abranger os ossos e articulações acima e abaixo da lesão; verificar a circulação (também podemos comprimir a unha e verificar o tempo) e sensação adequada antes e depois da tala.
Atenção: se PMS (pulse, movement and sensation) estiverem alterados distalmente a uma fratura, deve ser rapidamente imobilizado e a intervenção médica tem que ser feita em uma hora no máximo (normalmente em cirurgia),

Question 5

Quais os precedimentos de imobilização em caso de lesão musculoesquelética significativa?

Answer 5

Apoiar a parte lesada; cobrir qualquer ferida aberta com compressas e bandage; verificar a circulação distal; se usar ama tala rígida, deve almofadar-se; fixar a tala no local; reavaliar a sensação e a circulação; elevar a zona lesionada, se possível; averiguar ABCs e procurar sinais de choque.

Question 6

Quais as pontos chave em suspeita de fratura?

Answer 6

Um “pop” é sinal de fratura ou lesão ligamentar; o teste positivo com o diapasão e deformidade indica fratura; edema e sensibilidade ao toque; verificar a possibilidade de choque e ABC.

Question 7

Quais as pontos chave em estiramentos e entorses?

Answer 7

Strain - lesão tendinosa ou muscular, sprain -lesão ligamentar.
Testes especiais permitem diagnosticar este tipo de lesões; laxidão ligamentar anormal; edema da articulação; imobilização do osso acima e abaixo da articulação lesionada.

Question 8

Quais os mecanismos de lesão e sinal de deslocamento do ombro?

Answer 8

Abdução, rotação externa, golpe sobre a parte de trás do ombro ou uma queda sobre a mão estendida ou sobre o ombro.
Deformidade da articulação,

Question 9

Quais as considerações na redução ombro deslocado?

Answer 9

Os atletas devem reposicionar o seu próprio ombro, não o fisioterapeuta. É mais eficaz nos primeiros 30-45 seg após a lesão. Palpar o ombro e a clavícula, se houver sinais de fratura, o ombro não deve ser reposicionado!

Question 10

Qual o melhor critério para determinar o return to play?

Answer 10

Function is the most important criteria to use for return to play. Function incorporates strength, stability, level of pain, sensation, and proprioception. All of these must be intact in order for this athlete to return to competition safely.

Question 11

Após uma deslocação do ombro e sua redução usando o método de auto-distracção sentado, what criterion is essential determining return to play of the injured athlete?

Answer 11

It must be determined if any internal damage to the shoulder joint has occurred. This is best done with an x-ray and physician evaluation. There have been many instances where athletes have returned to play following a dislocation of the shoulder, but usual protocol calls for x-ray and physician evaluation, especially in first time dislocations.

Question 12

A player is knocked to the ground during a football game. He is unable to remove himself from the game. When you get to him on the field, he is lying supine conscious and complaining of severe pain on the shoulder. What is your first step in your evaluation of this athlete?

Answer 12

Check PMS (Pulse, movement, and sensation) to determine if you are working with an orthopedic emergency. If PMS is compromised, this constitutes an orthopedic emergency. EMS should be contacted and the findings reported. This is the most important step in the initial care of an injured extremity. Rule out the worst first.

Question 13

A player suffers an ankle sprain while running down the court. The injury occurred when the player stepped on the foot of another player. On examination on the sidelines the ankle appears to be stable without fracture signs or symptoms. Point tenderness was noted over to anterior talofibular ligament. What to do?

Answer 13

Tape ankle, check for function and decide on play or no play.

Tape will provide compression and support that will allow the player to return. If the player cannot perform functional tests, they cannot return. Functional tests includes running, planting, and cutting without limping.

Question 14

A player falls on his right shoulder during a soccer match. He comes to you on the sidelines with his arm hanging loosely at his side. Evaluation of this player reveals that he has no indication of fracture of the clavicle or humerus and no complete dislocation of the A/C joint. He does, however, have some elevation of the distal clavicle with localized tenderness. You diagnosis this as a Grade 1 A/C joint sprain. What are your criteria for return to play?

Answer 14

Full active ROM without pain will allow the player to return to the fullest capacity and perform their duties as expected. Although soccer does not involve a tremendous amount of upper extremity use, the movement of the injured extremity is utilized in the running movement and in contact with another player.

Question 15

A player falls on his right shoulder during a soccer match. He comes to you on the sidelines with his arm hanging loosely at his side. Considering the relative severity of these injuries, what is your primary concern?

Answer 15

Fracture of humerus or clavicle - The primary concern of the sports medicine provider on the sidelines should be to suspect the worst first. The worst in this case would be a fracture of the clavicle or humerus.

Question 16

An athlete is tackled. When you get to the field he is complaining of severe pain on the lateral aspect of high ankle. How do you respond?

Answer 16

Ask the athlete what happened and if he heard heard anything. Speaking with the athlete about the injury establishes ABC and will shed light on the injury itself. With the “pop” a fracture should be suspected. If a fracture is suspected, the ankle should be immobilized on the field to prevent any further soft tissue damage to the ankle. The athlete should be removed from the field non-weight bearing and evaluated more thoroughly on the sideline for the ankle injury and the possibility of injury to other joints.

Question 17

An athlete is tackled. When you get to the field he is complaining of severe pain on the lateral aspect of high ankle. You diagnose him with an ankle fracture in an angled position. What you should do?

Answer 17

Standard protocol is to splint the fracture in the position found. To attempt to reduce the fracture or to change the angulation of a fracture could result in further soft tissue damage, severe pain, and damage to the neurovascular structures at the fracture site.
An uncomplicated ankle fracture does not constitute an emergency. However, EMS may be contacted as needed to transport the athlete to the nearest hospital.

Question 18

A player is knocked to the ground during a football game. He is unable to remove himself from the game and palpation of the shoulder reveals a right shoulder dislocation. During emergency management, how is this player managed on the sidelines?

Answer 18

Rest, ice, compression, and elevation (RICE) are standard procedures for acute injuries on the sidelines. Rest prevents further injury.

Question 19

Quais os principais mecanismos de lesão?

Answer 19

The mechanism of injury can tell you a lot about which parts may be injured and how serious the injury may be:
– Direct force
– Indirect force
– Twisting/torsional force
– Shearing force
“Watch the players, not the game”

Question 20

A player falls on his right shoulder during a soccer match. He comes to you on the sidelines with his arm hanging loosely at his side. Considering the relative severity of these injuries, what is your primary concern?

Answer 20

Fracture of humerus or clavicle. The primary concern of the sports medicine provider on the sidelines should be to suspect the worst first. The worst in this case would be a fracture of the clavicle or humerus.

Question 21

You are the sports physical therapist assigned to cover a high school football game. Your tight end catches a pass down the sidelines and his headed for the goal line. A defensive back catches your tight end from behind and tackles him. As the tight end is going down you hear a “pop” from the play. When you get to the tight end on the field he is complaining of severe pain on the lateral aspect of high ankle. How do you respond?

Answer 21

Ask the athlete what happened and if he heard heard anything. Speaking with the athlete about the injury establishes ABC and will shed light on the injury itself. With the “pop” a fracture should be suspected. If a fracture is suspected, the ankle should be immobilized on the field to prevent any further soft tissue damage to the ankle. The athlete should be removed from the field non-weight bearing and evaluated more thoroughly on the sideline for the ankle injury and the possibility of injury to other joints.

Question 22

You are the sports physical therapist assigned to cover a high school football game. Your tight end catches a pass down the sidelines and his headed for the goal line. A defensive back catches your tight end from behind and tackles him. As the tight end is going down you hear a “pop” from the play. When you get to the tight end on the field he is complaining of severe pain on the lateral aspect of high ankle. You diagnose him with an ankle fracture. Should you find the fractured ankle in an angled position, you should:

Answer 22

Standard protocol is to splint the fracture in the position found. To attempt to reduce the fracture or to change the angulation of a fracture could result in further soft tissue damage, severe pain, and damage to the neurovascular structures at the fracture site.

EMS may be contacted as needed to transport the athlete to the nearest hospital. With proper immobilization, the athlete could be transported in a private automobile if deemed safe by the sports medicine staff. This is not an emergency situation. The ambulance travelling at emergency speed is placing the general public at risk and is not needed in this situation.

Question 23

A player is knocked to the ground during a football game. He is unable to remove himself from the game and palpation of the shoulder reveals a right shoulder dislocation. During emergency management, how is this player managed on the sidelines?

Answer 23

Rest, ice, and compression with ace bandage or equipment such as Game Ready will apply cold and compression to the injured site. Rest prevents further injury. Rest, ice, compression, and elevation (RICE) are standard procedures for acute injuries on the sidelines.
A sling may be applied at this time, as it may provide some relief of pain in the shoulder.

Question 24

Descreve os passos na aplicação de uma tala em caso de suspeita de fratura na perna.

Answer 24

• Cut-away or remove any clothing or equipment covering the area;
• Find a pedal pulse and mark it with the time and initials;
• Check movement and sensation;
• Immobilize the joints on each side of the injury (i.e. the knee and ankle);
• Check pulse, movement, and sensation after the splint
is applied.

Question 25

A player falls on his right shoulder during a soccer match. He comes to you on the sidelines with his arm hanging loosely at his side. Evaluation of this player reveals that he has no indication of fracture of the clavicle or humerus and no complete dislocation of the A/C joint. He does, however, have some elevation of the distal clavicle with localized tenderness. You diagnosis this as a Grade 1 A/C joint sprain. What are your criteria for return to play?

Answer 25

Full active ROM without pain will allow the player to return to the fullest capacity and perform their duties as expected.

Question 26

A player suffers an ankle sprain while running down the court. The injury occurred when the player stepped on the foot of another player. On examination on the sidelines the ankle appears to be stable without fracture signs or symptoms. Point tenderness was noted over to anterior talofibular ligament. Which could be the most appropriate course of action?

Answer 26

Tape ankle, check for function and decide on play or no play - tape will provide compression and support that will allow the player to return. If the player cannot perform functional tests, they cannot return.

Question 27

A player is knocked to the ground during a football game. He is unable to remove himself from the game. When you get to him on the field, he is lying supine complaining of severe pain in the right shoulder. His RUE is held in ABD and ER. Palpation of the shoulder reveals a right shoulder dislocation. Considering the emergency situation, what is your first step in your evaluation of this athlete, keeping in mind that he is conscious and complaining of severe pain?

Answer 27

Check PMS to determine if you are working with an orthopedic emergency. If PMS is compromised, this constitutes an orthopedic emergency. EMS should be contacted and the findings reported. This is the most important step in the initial care of an injured extremity. Rule out the worst first.

Question 28

A player is knocked to the ground during a football game. He is unable to remove himself from the game. When you get to him on the field, he is lying supine complaining of severe pain in the right shoulder. His RUE is held in ABD and ER. Palpation of the shoulder reveals a right shoulder dislocation. This player demonstrates normal pulse, movement, and sensation, and, in the absence of a clavicular or humeral fracture, self reduces his right shoulder using the sitting traction method. What criterion is essential determining return to play of the injured athlete?

Answer 28

It must be determined if any internal damage to the shoulder joint has occurred. This is best done with an x-ray and physician evaluation. There have been many instances where athletes have returned to play following a dislocation of the shoulder, but usual protocol calls for x-ray and physician evaluation, especially in first time dislocations.

Question 29

Qual é o critério mais importante para o return to play?

Answer 29

Function is the most important criteria to use for return to play. Function incorporates strength, stability, level of pain, sensation, and proprioception. All of these must be intact in order for this athlete to return to competition safely.